title: The development of bronchopleural fistula in lung cancer patients after major surgery: 31 years of experience with 19 cases.
abstract: OBJECTIVE
  The development of a bronchopleural fistula (BPF) after lung resection is a life-threatening complication, and thoracic surgeons should always consider the risk of BPF in their patients. We herein describe our experiences with BPF after major lung resection and describe the results of our management of the cases seen during the past 31 years.
  
  
  METHODS
  Between August 1979 and May 2010, 19 patients (1.3%) who underwent lung tumor resection developed a BPF. Their clinical records, associated risk factors, and outcomes, were retrospectively reviewed.
  
  
  RESULTS
  There were 14 patients who developed the BPF on the right side, and 5 who developed it on the left. All but one patient with BPF were male. There were prior and postoperative complicating diseases in 9 and 11 out of the 19 cases of BPF, respectively. The closure, using various techniques, was successful in 8 patients, while the repair failed in the other 11 patients, who subsequently developed further fatal complications. This gives a mortality rate of 57.9%. BPF occurred more frequently before 1994, in males, in those with stage T3-4 disease and/or metastasis to the lymph nodes, and in those who underwent a pneumonectomy. The incidence of BPF was higher in the patients who received preoperative chemotherapy and/or radiotherapy than in those who did not, although no significant influence of postoperative treatment was identified. The outcome was more favorable in those with left-sided tumor than in those whose tumors were on the right side. No significant correlation was identified between the outcome and concurrent disease, day of onset, preoperative treatment, postoperative treatment, preoperative chemotherapy, postoperative chemotherapy, preoperative radiotherapy, or the presence of a prior complicating disease. Interestingly, the existence of concurrent disease after the development of BPF, perioperative complications, and the development of an infection were significantly related to a poorer outcome.
  
  
  CONCLUSIONS
  BPF continues to have high morbidity and mortality rates. Thoracic surgeons should pay special attention to the risk factors that affect the development and successful treatment of a BPF. Establishment of standard treatments and guidelines for the prevention and proper treatment of BPF are needed.
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan. hidetaka@med.uoeh-u.ac.jp
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hanagiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010995:Pleural Diseases / Q000209:etiology* / Q000473:pathology; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects; D055815:Young Adult